АНАЛИЗ ВОЗМОЖНОСТЕЙ ПРИМЕНЕНИЯ НОВОГО МЕТОДА ОПРЕДЕЛЕНИЯ УРОВНЯ D-ДИМЕРА В ПЛАЗМЕ КРОВИ У БОЛЬНЫХ С COVID-19 НА ГОСПИТАЛЬНОМ ЭТАПЕ

Abstract

Introduction. The outbreak of the novel viral infection SARS-CoV-2 and its associated pandemic has generated significant interest among professionals regarding the role of D-dimer as a marker. D-dimer not only reflects the intensity of hemostatic and fibrinolytic reactions but also holds prognostic value. However, the standardization of D-dimer determination remains elusive, as the findings are known to depend on the completeness of fibrinolysis in the vasculature. Objective. This study aims to investigate the objective values of D-dimer levels, taking into consideration the concentration of its terminal fragments in plasma, specifically in patients with intravascular thrombosis associated with coronavirus infection. Materials and Methods. The study involved the examination of sodium citrate-stabilized plasma from 90 patients with severe COVID-19 who required respiratory support upon admission to the intensive care unit (ICU). The ICU mortality rate was 50% within 14 days. Additionally, a control group of 78 healthy individuals was included. The quantitative determination of D-dimer in human plasma was conducted using the Auto Red D-Dimer 700 (Helena Bioscience) and Sysmex CA1500 coagulation analyzer (Sysmex Corporation). Fibrinolysis was stimulated in vitro by streptokinase during sample preparation. The assessment was based on the analysis of blood plasma before and after the administration of the fibrinolysis activator. Results. Using the classical method of determination, D-dimer levels exceeded the cut-off value (300 ng/ml) in 61 out of 90 patients (67.8%). After fibrinolysis stimulation with streptokinase, this number increased to 66 (73.3%). Compared to the survival group, the fatal outcome group exhibited a 143.6% higher D-dimer level using the classical approach (p=0.2355). With the new approach involving streptokinase, the increase was 181.2% (p=0.0257). In one-fifth of fatal cases, the streptokinase-induced D-dimer concentration was more than twice the baseline obtained through the classical approach. Conclusion. The proposed approach for quantitatively determining D-dimer, which incorporates the use of streptokinase, provides more accurate data regarding the plasma concentration of D-dimer neoantigens. These findings establish a potential direction for standardizing such studies in clinical practice, particularly for determining treatment strategies for patients with COVID-19.